急性左心衰竭并休克病人动脉内血压监测指导血管活性药物应用  

The Usage of Vase-Active Agents Guided by Invasive Arterial Pressure Monitoring in Patients with Acute Left Heart Failure and Cardiogenic Shock

作　　者：谭慧琼[1] 朱俊[1] 宋有城[1] 袁贤奇[1] 杨艳敏[1] 贺丽霞[1] 郝云霞[1] 欧阳泽伟[1] 

机构地区：[1]中国医学科学院

出　　处：《中国循环杂志》2001年第4期265-266,共2页Chinese Circulation Journal

摘　　要：目的：探讨动脉内血压监测在急性左心衰竭并休克病人抢救治疗中对血管活性药物的指导作用。　　　　方法：急性左心衰竭并休克的重症心脏病人１２例，左心室射血分数０．３５±０．１０，均应用了多巴胺静脉注射并静脉维持７６６．７±３１１．１μｇ／ｍｉｎ，血压仍不回升，７例病人周围血压为０，５例收缩期血压仅５０～８０ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ），心率１１７±１５次／分。我们在常规对症治疗、强心、利尿的基础上，进行动脉内血压监测指导血管活性药物治疗。　　　　结果：动脉内血压监测示收缩压１０４．６±１５．８ｍｍＨｇ、舒张压６６．９±１３．９ｍｍＨｇ。根据动脉内血压监测调整血管活性药物。多巴胺静脉最大维持量１０１２．５±３９３．８μｇ／ｍｉｎ，在此基础上联合硝普钠小剂量开始应用，逐渐加量至３０．６±２３．６μｇ／ｍｉｎ，半数病人同时应用多巴酚丁胺１５０～３００μｇ／ｍｉｎ以维持动脉内收缩期血压９０～１００ｍｍＨｇ。５例（５／１２）病人休克得到纠正，心力衰竭减轻，随访１个月病人稳定；２例病人病情无变化自动出院；５例（５／１２）病人经抢救治疗无效死亡。　　　　结论：在动脉内血压监测指导下，应用大剂量多巴胺并小剂量硝普钠治?Objective:To investigate the role of invasive arterial pressure monitoring in the proper usage of vaso-active agents in patients with acute severe left heart failure and cardiogenic shock. Methods:Invasive arterial pressure monitoring were performed in 12 patients with acute severe left heart failure complicated by cardiogenic shock.Mean LVEF was 0.35±0.10.Heart rate was 117±15 beats/min.Systolic blood pressure by sphygmoma nometer was 0 in 7 patients and only 50-80 mmHg in 5 patients despite intravenous bolus and aintenance dopamine in the dose of 766.7 311.1μg/min.Vasodilator therapy(nitroprusside)was added to the re gular management under the guidance of invasive arterial pressure monitoring. Results:The pressure value by invasive arterial pressure monitoring was 104.6± 15.8mmHg/66.9±13.9mmHg.The dose of vasod ilator and inotropes was adjusted to mai ntain systolic pressure between 90 to 10 0 mmHg.The highest dosage of intravenous dopamine was 1012.5±393.8 μg/min.Nitro prusside was started with lower dose and titrated up to 30.6±23.6μg/min.Dobut amine was also used in 50% of the patients.Five patients(5/12)had clinical improvem ent and were discharged from hospital wi th stable hemodynamic status.Two patient.s condition was not improved.Five patie nts(5/12)died. Conclusion:Under the guidance of invas ive arterial pressure monitoring,high do se of dopamine combined with low dose ni troprusside can improve the outcome of p atient with acute severe left heart fail ure and cardiogenic shock.

关 键 词：急性左心衰竭 休克 心力衰竭 动脉内血压 监测 血管活性药物 应用 

分 类 号：R541.6[医药卫生—心血管疾病]